Charlotte County, Florida Obamacare 2024 Rates

ADVERTISEMENT

Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Charlotte County, FL.

The health insurance rates listed below are for calendar year 2024.

For information on subsidies to make your coverage affordable, you must take one of the following actions:

  • Contact a licensed health insurance agent
  • Complete an application at Healthcare.gov
  • Contact the provider directly

Obamacare Providers, 107 Plans and 2024 Rates for Charlotte County, Florida

Below, you’ll find a summary of the 107 plans for Charlotte County, Florida and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.


Obamacare Rates and Providers for Other Years

2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |



ADVERTISEMENT

Florida Blue (BlueCross BlueShield FL)

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

Toc - Plan #1 Florida Blue (BlueCross BlueShield FL)
Bronze

(EPO) BlueSelect Bronze 24L01-01 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,150 $12,300 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$314.44
$356.89
$401.85
$561.59
$853.39
$554.99
$597.44
$642.40
$802.14
$795.54
$837.99
$882.95
$1,042.69
$1,036.09
$1,078.54
$1,123.50
$1,283.24
$240.55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$628.88
$713.78
$803.70
$1,123.18
$1,706.78
$869.43
$954.33
$1,044.25
$1,363.73
$1,109.98
$1,194.88
$1,284.80
$1,604.28
$1,350.53
$1,435.43
$1,525.35
$1,844.83
$240.55
Toc - Plan #2 Florida Blue (BlueCross BlueShield FL)
Silver

(EPO) BlueSelect Silver 1456 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$2,800 $5,600 Annual Deductible
$7,150 $14,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$426.64
$484.24
$545.25
$761.98
$1,157.90
$753.02
$810.62
$871.63
$1,088.36
$1,079.40
$1,137.00
$1,198.01
$1,414.74
$1,405.78
$1,463.38
$1,524.39
$1,741.12
$326.38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$853.28
$968.48
$1,090.50
$1,523.96
$2,315.80
$1,179.66
$1,294.86
$1,416.88
$1,850.34
$1,506.04
$1,621.24
$1,743.26
$2,176.72
$1,832.42
$1,947.62
$2,069.64
$2,503.10
$326.38
Toc - Plan #3 Florida Blue (BlueCross BlueShield FL)
Platinum

(EPO) BlueSelect Platinum 1451 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$4,000 $8,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$560.02
$635.62
$715.71
$1,000.20
$1,519.89
$988.44
$1,064.04
$1,144.13
$1,428.62
$1,416.86
$1,492.46
$1,572.55
$1,857.04
$1,845.28
$1,920.88
$2,000.97
$2,285.46
$428.42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,120.04
$1,271.24
$1,431.42
$2,000.40
$3,039.78
$1,548.46
$1,699.66
$1,859.84
$2,428.82
$1,976.88
$2,128.08
$2,288.26
$2,857.24
$2,405.30
$2,556.50
$2,716.68
$3,285.66
$428.42
Toc - Plan #4 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(EPO) BlueSelect Bronze 1449 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$336.05
$381.42
$429.47
$600.19
$912.04
$593.13
$638.50
$686.55
$857.27
$850.21
$895.58
$943.63
$1,114.35
$1,107.29
$1,152.66
$1,200.71
$1,371.43
$257.08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$672.10
$762.84
$858.94
$1,200.38
$1,824.08
$929.18
$1,019.92
$1,116.02
$1,457.46
$1,186.26
$1,277.00
$1,373.10
$1,714.54
$1,443.34
$1,534.08
$1,630.18
$1,971.62
$257.08
Toc - Plan #5 Florida Blue (BlueCross BlueShield FL)
Platinum

(EPO) BlueSelect Platinum 1457 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$581.89
$660.45
$743.66
$1,039.26
$1,579.25
$1,027.04
$1,105.60
$1,188.81
$1,484.41
$1,472.19
$1,550.75
$1,633.96
$1,929.56
$1,917.34
$1,995.90
$2,079.11
$2,374.71
$445.15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,163.78
$1,320.90
$1,487.32
$2,078.52
$3,158.50
$1,608.93
$1,766.05
$1,932.47
$2,523.67
$2,054.08
$2,211.20
$2,377.62
$2,968.82
$2,499.23
$2,656.35
$2,822.77
$3,413.97
$445.15
Toc - Plan #6 Florida Blue (BlueCross BlueShield FL)
Silver

(EPO) BlueSelect Silver 1443 ($0 Virtual Visits / $0 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$399.35
$453.26
$510.37
$713.24
$1,083.84
$704.85
$758.76
$815.87
$1,018.74
$1,010.35
$1,064.26
$1,121.37
$1,324.24
$1,315.85
$1,369.76
$1,426.87
$1,629.74
$305.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$798.70
$906.52
$1,020.74
$1,426.48
$2,167.68
$1,104.20
$1,212.02
$1,326.24
$1,731.98
$1,409.70
$1,517.52
$1,631.74
$2,037.48
$1,715.20
$1,823.02
$1,937.24
$2,342.98
$305.50
Toc - Plan #7 Florida Blue (BlueCross BlueShield FL)
Gold

(EPO) BlueSelect Gold 1535 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$6,250 $12,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$481.22
$546.18
$615.00
$859.46
$1,306.03
$849.35
$914.31
$983.13
$1,227.59
$1,217.48
$1,282.44
$1,351.26
$1,595.72
$1,585.61
$1,650.57
$1,719.39
$1,963.85
$368.13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$962.44
$1,092.36
$1,230.00
$1,718.92
$2,612.06
$1,330.57
$1,460.49
$1,598.13
$2,087.05
$1,698.70
$1,828.62
$1,966.26
$2,455.18
$2,066.83
$2,196.75
$2,334.39
$2,823.31
$368.13
Toc - Plan #8 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(EPO) BlueSelect Bronze (HSA) 1735 (Rewards $$$ / $4 Condition Care Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$7,050 $14,100 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$327.24
$371.42
$418.21
$584.45
$888.13
$577.58
$621.76
$668.55
$834.79
$827.92
$872.10
$918.89
$1,085.13
$1,078.26
$1,122.44
$1,169.23
$1,335.47
$250.34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$654.48
$742.84
$836.42
$1,168.90
$1,776.26
$904.82
$993.18
$1,086.76
$1,419.24
$1,155.16
$1,243.52
$1,337.10
$1,669.58
$1,405.50
$1,493.86
$1,587.44
$1,919.92
$250.34
Toc - Plan #9 Florida Blue (BlueCross BlueShield FL)
Gold

(EPO) BlueSelect Gold 1835 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$5,900 $11,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$467.30
$530.39
$597.21
$834.60
$1,268.25
$824.78
$887.87
$954.69
$1,192.08
$1,182.26
$1,245.35
$1,312.17
$1,549.56
$1,539.74
$1,602.83
$1,669.65
$1,907.04
$357.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$934.60
$1,060.78
$1,194.42
$1,669.20
$2,536.50
$1,292.08
$1,418.26
$1,551.90
$2,026.68
$1,649.56
$1,775.74
$1,909.38
$2,384.16
$2,007.04
$2,133.22
$2,266.86
$2,741.64
$357.48
Toc - Plan #10 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(EPO) BlueSelect Bronze 2139 ($0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$351.93
$399.44
$449.77
$628.55
$955.14
$621.16
$668.67
$719.00
$897.78
$890.39
$937.90
$988.23
$1,167.01
$1,159.62
$1,207.13
$1,257.46
$1,436.24
$269.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$703.86
$798.88
$899.54
$1,257.10
$1,910.28
$973.09
$1,068.11
$1,168.77
$1,526.33
$1,242.32
$1,337.34
$1,438.00
$1,795.56
$1,511.55
$1,606.57
$1,707.23
$2,064.79
$269.23
Toc - Plan #11 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(EPO) BlueSelect Bronze 2342S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$329.89
$374.43
$421.60
$589.18
$895.32
$582.26
$626.80
$673.97
$841.55
$834.63
$879.17
$926.34
$1,093.92
$1,087.00
$1,131.54
$1,178.71
$1,346.29
$252.37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$659.78
$748.86
$843.20
$1,178.36
$1,790.64
$912.15
$1,001.23
$1,095.57
$1,430.73
$1,164.52
$1,253.60
$1,347.94
$1,683.10
$1,416.89
$1,505.97
$1,600.31
$1,935.47
$252.37
Toc - Plan #12 Florida Blue (BlueCross BlueShield FL)
Silver

(EPO) BlueSelect Silver 2343S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$414.84
$470.84
$530.17
$740.90
$1,125.88
$732.19
$788.19
$847.52
$1,058.25
$1,049.54
$1,105.54
$1,164.87
$1,375.60
$1,366.89
$1,422.89
$1,482.22
$1,692.95
$317.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$829.68
$941.68
$1,060.34
$1,481.80
$2,251.76
$1,147.03
$1,259.03
$1,377.69
$1,799.15
$1,464.38
$1,576.38
$1,695.04
$2,116.50
$1,781.73
$1,893.73
$2,012.39
$2,433.85
$317.35
Toc - Plan #13 Florida Blue (BlueCross BlueShield FL)
Gold

(EPO) BlueSelect Gold 2344S ($30 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$455.58
$517.08
$582.23
$813.67
$1,236.44
$804.10
$865.60
$930.75
$1,162.19
$1,152.62
$1,214.12
$1,279.27
$1,510.71
$1,501.14
$1,562.64
$1,627.79
$1,859.23
$348.52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$911.16
$1,034.16
$1,164.46
$1,627.34
$2,472.88
$1,259.68
$1,382.68
$1,512.98
$1,975.86
$1,608.20
$1,731.20
$1,861.50
$2,324.38
$1,956.72
$2,079.72
$2,210.02
$2,672.90
$348.52
Toc - Plan #14 Florida Blue (BlueCross BlueShield FL)
Platinum

(EPO) BlueSelect Platinum 2345S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$578.68
$656.80
$739.55
$1,033.52
$1,570.54
$1,021.37
$1,099.49
$1,182.24
$1,476.21
$1,464.06
$1,542.18
$1,624.93
$1,918.90
$1,906.75
$1,984.87
$2,067.62
$2,361.59
$442.69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,157.36
$1,313.60
$1,479.10
$2,067.04
$3,141.08
$1,600.05
$1,756.29
$1,921.79
$2,509.73
$2,042.74
$2,198.98
$2,364.48
$2,952.42
$2,485.43
$2,641.67
$2,807.17
$3,395.11
$442.69
Toc - Plan #15 Florida Blue (BlueCross BlueShield FL)
Silver

(PPO) BlueOptions Silver 24J01-03 ($0 Virtual Visits / $0 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$626.65
$711.25
$800.86
$1,119.20
$1,700.73
$1,106.04
$1,190.64
$1,280.25
$1,598.59
$1,585.43
$1,670.03
$1,759.64
$2,077.98
$2,064.82
$2,149.42
$2,239.03
$2,557.37
$479.39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,253.30
$1,422.50
$1,601.72
$2,238.40
$3,401.46
$1,732.69
$1,901.89
$2,081.11
$2,717.79
$2,212.08
$2,381.28
$2,560.50
$3,197.18
$2,691.47
$2,860.67
$3,039.89
$3,676.57
$479.39
Toc - Plan #16 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(PPO) BlueOptions Bronze 24J01-04 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$447.90
$508.37
$572.42
$799.95
$1,215.60
$790.54
$851.01
$915.06
$1,142.59
$1,133.18
$1,193.65
$1,257.70
$1,485.23
$1,475.82
$1,536.29
$1,600.34
$1,827.87
$342.64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$895.80
$1,016.74
$1,144.84
$1,599.90
$2,431.20
$1,238.44
$1,359.38
$1,487.48
$1,942.54
$1,581.08
$1,702.02
$1,830.12
$2,285.18
$1,923.72
$2,044.66
$2,172.76
$2,627.82
$342.64
Toc - Plan #17 Florida Blue (BlueCross BlueShield FL)
Platinum

(PPO) BlueOptions Platinum 24J01-05 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$4,000 $8,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$845.56
$959.71
$1,080.63
$1,510.17
$2,294.85
$1,492.41
$1,606.56
$1,727.48
$2,157.02
$2,139.26
$2,253.41
$2,374.33
$2,803.87
$2,786.11
$2,900.26
$3,021.18
$3,450.72
$646.85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,691.12
$1,919.42
$2,161.26
$3,020.34
$4,589.70
$2,337.97
$2,566.27
$2,808.11
$3,667.19
$2,984.82
$3,213.12
$3,454.96
$4,314.04
$3,631.67
$3,859.97
$4,101.81
$4,960.89
$646.85
Toc - Plan #18 Florida Blue (BlueCross BlueShield FL)
Bronze

(PPO) BlueOptions Bronze 24J01-06 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,150 $12,300 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$419.05
$475.62
$535.55
$748.42
$1,137.30
$739.62
$796.19
$856.12
$1,068.99
$1,060.19
$1,116.76
$1,176.69
$1,389.56
$1,380.76
$1,437.33
$1,497.26
$1,710.13
$320.57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$838.10
$951.24
$1,071.10
$1,496.84
$2,274.60
$1,158.67
$1,271.81
$1,391.67
$1,817.41
$1,479.24
$1,592.38
$1,712.24
$2,137.98
$1,799.81
$1,912.95
$2,032.81
$2,458.55
$320.57
Toc - Plan #19 Florida Blue (BlueCross BlueShield FL)
Silver

(PPO) BlueOptions Silver 24J01-07 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$2,800 $5,600 Annual Deductible
$7,150 $14,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$670.35
$760.85
$856.71
$1,197.25
$1,819.33
$1,183.17
$1,273.67
$1,369.53
$1,710.07
$1,695.99
$1,786.49
$1,882.35
$2,222.89
$2,208.81
$2,299.31
$2,395.17
$2,735.71
$512.82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,340.70
$1,521.70
$1,713.42
$2,394.50
$3,638.66
$1,853.52
$2,034.52
$2,226.24
$2,907.32
$2,366.34
$2,547.34
$2,739.06
$3,420.14
$2,879.16
$3,060.16
$3,251.88
$3,932.96
$512.82
Toc - Plan #20 Florida Blue (BlueCross BlueShield FL)
Platinum

(PPO) BlueOptions Platinum 24J01-08 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$879.47
$998.20
$1,123.96
$1,570.73
$2,386.88
$1,552.26
$1,670.99
$1,796.75
$2,243.52
$2,225.05
$2,343.78
$2,469.54
$2,916.31
$2,897.84
$3,016.57
$3,142.33
$3,589.10
$672.79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,758.94
$1,996.40
$2,247.92
$3,141.46
$4,773.76
$2,431.73
$2,669.19
$2,920.71
$3,814.25
$3,104.52
$3,341.98
$3,593.50
$4,487.04
$3,777.31
$4,014.77
$4,266.29
$5,159.83
$672.79
Toc - Plan #21 Florida Blue (BlueCross BlueShield FL)
Gold

(PPO) BlueOptions Gold 24J01-09 ($0 Virtual Visits / $20 PCP Visits / $15 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$6,250 $12,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$721.62
$819.04
$922.23
$1,288.81
$1,958.48
$1,273.66
$1,371.08
$1,474.27
$1,840.85
$1,825.70
$1,923.12
$2,026.31
$2,392.89
$2,377.74
$2,475.16
$2,578.35
$2,944.93
$552.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,443.24
$1,638.08
$1,844.46
$2,577.62
$3,916.96
$1,995.28
$2,190.12
$2,396.50
$3,129.66
$2,547.32
$2,742.16
$2,948.54
$3,681.70
$3,099.36
$3,294.20
$3,500.58
$4,233.74
$552.04
Toc - Plan #22 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(PPO) BlueOptions Bronze (HSA) 24J01-10 (Rewards $$$ / $4 Condition Care Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$7,050 $14,100 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$435.67
$494.49
$556.79
$778.11
$1,182.41
$768.96
$827.78
$890.08
$1,111.40
$1,102.25
$1,161.07
$1,223.37
$1,444.69
$1,435.54
$1,494.36
$1,556.66
$1,777.98
$333.29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$871.34
$988.98
$1,113.58
$1,556.22
$2,364.82
$1,204.63
$1,322.27
$1,446.87
$1,889.51
$1,537.92
$1,655.56
$1,780.16
$2,222.80
$1,871.21
$1,988.85
$2,113.45
$2,556.09
$333.29
Toc - Plan #23 Florida Blue (BlueCross BlueShield FL)
Gold

(PPO) BlueOptions Gold 24J01-12 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$5,900 $11,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$700.29
$794.83
$894.97
$1,250.72
$1,900.59
$1,236.01
$1,330.55
$1,430.69
$1,786.44
$1,771.73
$1,866.27
$1,966.41
$2,322.16
$2,307.45
$2,401.99
$2,502.13
$2,857.88
$535.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,400.58
$1,589.66
$1,789.94
$2,501.44
$3,801.18
$1,936.30
$2,125.38
$2,325.66
$3,037.16
$2,472.02
$2,661.10
$2,861.38
$3,572.88
$3,007.74
$3,196.82
$3,397.10
$4,108.60
$535.72
Toc - Plan #24 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(PPO) BlueOptions Bronze 24J01-17 ($0 Virtual Visits / $50 PCP Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$468.98
$532.29
$599.36
$837.60
$1,272.81
$827.75
$891.06
$958.13
$1,196.37
$1,186.52
$1,249.83
$1,316.90
$1,555.14
$1,545.29
$1,608.60
$1,675.67
$1,913.91
$358.77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$937.96
$1,064.58
$1,198.72
$1,675.20
$2,545.62
$1,296.73
$1,423.35
$1,557.49
$2,033.97
$1,655.50
$1,782.12
$1,916.26
$2,392.74
$2,014.27
$2,140.89
$2,275.03
$2,751.51
$358.77
Toc - Plan #25 Florida Blue (BlueCross BlueShield FL)
Expanded Bronze

(PPO) BlueOptions Bronze 24J01-18S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$439.03
$498.30
$561.08
$784.11
$1,191.53
$774.89
$834.16
$896.94
$1,119.97
$1,110.75
$1,170.02
$1,232.80
$1,455.83
$1,446.61
$1,505.88
$1,568.66
$1,791.69
$335.86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$878.06
$996.60
$1,122.16
$1,568.22
$2,383.06
$1,213.92
$1,332.46
$1,458.02
$1,904.08
$1,549.78
$1,668.32
$1,793.88
$2,239.94
$1,885.64
$2,004.18
$2,129.74
$2,575.80
$335.86
Toc - Plan #26 Florida Blue (BlueCross BlueShield FL)
Silver

(PPO) BlueOptions Silver 24J01-19S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$651.27
$739.19
$832.32
$1,163.17
$1,767.55
$1,149.49
$1,237.41
$1,330.54
$1,661.39
$1,647.71
$1,735.63
$1,828.76
$2,159.61
$2,145.93
$2,233.85
$2,326.98
$2,657.83
$498.22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,302.54
$1,478.38
$1,664.64
$2,326.34
$3,535.10
$1,800.76
$1,976.60
$2,162.86
$2,824.56
$2,298.98
$2,474.82
$2,661.08
$3,322.78
$2,797.20
$2,973.04
$3,159.30
$3,821.00
$498.22
Toc - Plan #27 Florida Blue (BlueCross BlueShield FL)
Gold

(PPO) BlueOptions Gold 24J01-20S ($30 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$683.00
$775.21
$872.87
$1,219.84
$1,853.66
$1,205.50
$1,297.71
$1,395.37
$1,742.34
$1,728.00
$1,820.21
$1,917.87
$2,264.84
$2,250.50
$2,342.71
$2,440.37
$2,787.34
$522.50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,366.00
$1,550.42
$1,745.74
$2,439.68
$3,707.32
$1,888.50
$2,072.92
$2,268.24
$2,962.18
$2,411.00
$2,595.42
$2,790.74
$3,484.68
$2,933.50
$3,117.92
$3,313.24
$4,007.18
$522.50
Toc - Plan #28 Florida Blue (BlueCross BlueShield FL)
Platinum

(PPO) BlueOptions Platinum 24J01-21S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$873.97
$991.96
$1,116.93
$1,560.91
$2,371.95
$1,542.56
$1,660.55
$1,785.52
$2,229.50
$2,211.15
$2,329.14
$2,454.11
$2,898.09
$2,879.74
$2,997.73
$3,122.70
$3,566.68
$668.59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,747.94
$1,983.92
$2,233.86
$3,121.82
$4,743.90
$2,416.53
$2,652.51
$2,902.45
$3,790.41
$3,085.12
$3,321.10
$3,571.04
$4,459.00
$3,753.71
$3,989.69
$4,239.63
$5,127.59
$668.59

ADVERTISEMENT

Aetna CVS Health

Local: 1-877-336-3915 | Toll Free: 1-877-336-3915

Toc - Plan #29 Aetna CVS Health
Silver

(HMO) Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$363.77
$412.88
$464.90
$649.70
$987.28
$642.06
$691.17
$743.19
$927.99
$920.35
$969.46
$1,021.48
$1,206.28
$1,198.64
$1,247.75
$1,299.77
$1,484.57
$278.29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$727.54
$825.76
$929.80
$1,299.40
$1,974.56
$1,005.83
$1,104.05
$1,208.09
$1,577.69
$1,284.12
$1,382.34
$1,486.38
$1,855.98
$1,562.41
$1,660.63
$1,764.67
$2,134.27
$278.29
Toc - Plan #30 Aetna CVS Health
Expanded Bronze

(HMO) Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$290.49
$329.71
$371.25
$518.81
$788.38
$512.72
$551.94
$593.48
$741.04
$734.95
$774.17
$815.71
$963.27
$957.18
$996.40
$1,037.94
$1,185.50
$222.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$580.98
$659.42
$742.50
$1,037.62
$1,576.76
$803.21
$881.65
$964.73
$1,259.85
$1,025.44
$1,103.88
$1,186.96
$1,482.08
$1,247.67
$1,326.11
$1,409.19
$1,704.31
$222.23
Toc - Plan #31 Aetna CVS Health
Silver

(HMO) Silver 5: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$8,395 $16,790 Annual Deductible
$8,885 $17,770 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$363.54
$412.61
$464.60
$649.27
$986.63
$641.65
$690.72
$742.71
$927.38
$919.76
$968.83
$1,020.82
$1,205.49
$1,197.87
$1,246.94
$1,298.93
$1,483.60
$278.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$727.08
$825.22
$929.20
$1,298.54
$1,973.26
$1,005.19
$1,103.33
$1,207.31
$1,576.65
$1,283.30
$1,381.44
$1,485.42
$1,854.76
$1,561.41
$1,659.55
$1,763.53
$2,132.87
$278.11
Toc - Plan #32 Aetna CVS Health
Gold

(HMO) Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$388.80
$441.29
$496.89
$694.40
$1,055.21
$686.24
$738.73
$794.33
$991.84
$983.68
$1,036.17
$1,091.77
$1,289.28
$1,281.12
$1,333.61
$1,389.21
$1,586.72
$297.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$777.60
$882.58
$993.78
$1,388.80
$2,110.42
$1,075.04
$1,180.02
$1,291.22
$1,686.24
$1,372.48
$1,477.46
$1,588.66
$1,983.68
$1,669.92
$1,774.90
$1,886.10
$2,281.12
$297.44
Toc - Plan #33 Aetna CVS Health
Silver

(HMO) Silver 6: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,795 $15,590 Annual Deductible
$8,445 $16,890 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$371.20
$421.31
$474.39
$662.96
$1,007.43
$655.17
$705.28
$758.36
$946.93
$939.14
$989.25
$1,042.33
$1,230.90
$1,223.11
$1,273.22
$1,326.30
$1,514.87
$283.97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$742.40
$842.62
$948.78
$1,325.92
$2,014.86
$1,026.37
$1,126.59
$1,232.75
$1,609.89
$1,310.34
$1,410.56
$1,516.72
$1,893.86
$1,594.31
$1,694.53
$1,800.69
$2,177.83
$283.97
Toc - Plan #34 Aetna CVS Health
Expanded Bronze

(HMO) Bronze 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$319.91
$363.09
$408.84
$571.35
$868.22
$564.64
$607.82
$653.57
$816.08
$809.37
$852.55
$898.30
$1,060.81
$1,054.10
$1,097.28
$1,143.03
$1,305.54
$244.73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$639.82
$726.18
$817.68
$1,142.70
$1,736.44
$884.55
$970.91
$1,062.41
$1,387.43
$1,129.28
$1,215.64
$1,307.14
$1,632.16
$1,374.01
$1,460.37
$1,551.87
$1,876.89
$244.73
Toc - Plan #35 Aetna CVS Health
Gold

(HMO) Gold 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$795 $1,590 Annual Deductible
$9,195 $18,390 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$387.24
$439.52
$494.90
$691.61
$1,050.97
$683.48
$735.76
$791.14
$987.85
$979.72
$1,032.00
$1,087.38
$1,284.09
$1,275.96
$1,328.24
$1,383.62
$1,580.33
$296.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$774.48
$879.04
$989.80
$1,383.22
$2,101.94
$1,070.72
$1,175.28
$1,286.04
$1,679.46
$1,366.96
$1,471.52
$1,582.28
$1,975.70
$1,663.20
$1,767.76
$1,878.52
$2,271.94
$296.24
Toc - Plan #36 Aetna CVS Health
Gold

(HMO) Gold 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$392.40
$445.38
$501.49
$700.83
$1,064.97
$692.59
$745.57
$801.68
$1,001.02
$992.78
$1,045.76
$1,101.87
$1,301.21
$1,292.97
$1,345.95
$1,402.06
$1,601.40
$300.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$784.80
$890.76
$1,002.98
$1,401.66
$2,129.94
$1,084.99
$1,190.95
$1,303.17
$1,701.85
$1,385.18
$1,491.14
$1,603.36
$2,002.04
$1,685.37
$1,791.33
$1,903.55
$2,302.23
$300.19
Toc - Plan #37 Aetna CVS Health
Silver

(HMO) Silver 7: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-336-3915

Annual Out of Pocket Expenses:

Individual Family
$7,795 $15,590 Annual Deductible
$8,845 $17,690 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$371.37
$421.51
$474.61
$663.27
$1,007.90
$655.47
$705.61
$758.71
$947.37
$939.57
$989.71
$1,042.81
$1,231.47
$1,223.67
$1,273.81
$1,326.91
$1,515.57
$284.10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$742.74
$843.02
$949.22
$1,326.54
$2,015.80
$1,026.84
$1,127.12
$1,233.32
$1,610.64
$1,310.94
$1,411.22
$1,517.42
$1,894.74
$1,595.04
$1,695.32
$1,801.52
$2,178.84
$284.10

ADVERTISEMENT

Ambetter from Sunshine Health

Local: 1-877-687-1169 | Toll Free: 1-877-687-1169 | TTY: 1-800-955-8770

Toc - Plan #38 Ambetter from Sunshine Health
Gold

(EPO) Complete Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$387.67
$439.99
$495.42
$692.35
$1,052.10
$684.23
$736.55
$791.98
$988.91
$980.79
$1,033.11
$1,088.54
$1,285.47
$1,277.35
$1,329.67
$1,385.10
$1,582.03
$296.56
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$775.34
$879.98
$990.84
$1,384.70
$2,104.20
$1,071.90
$1,176.54
$1,287.40
$1,681.26
$1,368.46
$1,473.10
$1,583.96
$1,977.82
$1,665.02
$1,769.66
$1,880.52
$2,274.38
$296.56
Toc - Plan #39 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Choice Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$320.23
$363.45
$409.24
$571.92
$869.08
$565.20
$608.42
$654.21
$816.89
$810.17
$853.39
$899.18
$1,061.86
$1,055.14
$1,098.36
$1,144.15
$1,306.83
$244.97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$640.46
$726.90
$818.48
$1,143.84
$1,738.16
$885.43
$971.87
$1,063.45
$1,388.81
$1,130.40
$1,216.84
$1,308.42
$1,633.78
$1,375.37
$1,461.81
$1,553.39
$1,878.75
$244.97
Toc - Plan #40 Ambetter from Sunshine Health
Silver

(EPO) Everyday Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$404.18
$458.73
$516.53
$721.85
$1,096.92
$713.37
$767.92
$825.72
$1,031.04
$1,022.56
$1,077.11
$1,134.91
$1,340.23
$1,331.75
$1,386.30
$1,444.10
$1,649.42
$309.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$808.36
$917.46
$1,033.06
$1,443.70
$2,193.84
$1,117.55
$1,226.65
$1,342.25
$1,752.89
$1,426.74
$1,535.84
$1,651.44
$2,062.08
$1,735.93
$1,845.03
$1,960.63
$2,371.27
$309.19
Toc - Plan #41 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Everyday Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$315.88
$358.51
$403.68
$564.14
$857.27
$557.52
$600.15
$645.32
$805.78
$799.16
$841.79
$886.96
$1,047.42
$1,040.80
$1,083.43
$1,128.60
$1,289.06
$241.64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$631.76
$717.02
$807.36
$1,128.28
$1,714.54
$873.40
$958.66
$1,049.00
$1,369.92
$1,115.04
$1,200.30
$1,290.64
$1,611.56
$1,356.68
$1,441.94
$1,532.28
$1,853.20
$241.64
Toc - Plan #42 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Elite Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$362.68
$411.63
$463.49
$647.72
$984.28
$640.12
$689.07
$740.93
$925.16
$917.56
$966.51
$1,018.37
$1,202.60
$1,195.00
$1,243.95
$1,295.81
$1,480.04
$277.44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$725.36
$823.26
$926.98
$1,295.44
$1,968.56
$1,002.80
$1,100.70
$1,204.42
$1,572.88
$1,280.24
$1,378.14
$1,481.86
$1,850.32
$1,557.68
$1,655.58
$1,759.30
$2,127.76
$277.44
Toc - Plan #43 Ambetter from Sunshine Health
Silver

(EPO) Clear Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$5,400 $10,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$393.63
$446.76
$503.04
$703.00
$1,068.28
$694.75
$747.88
$804.16
$1,004.12
$995.87
$1,049.00
$1,105.28
$1,305.24
$1,296.99
$1,350.12
$1,406.40
$1,606.36
$301.12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$787.26
$893.52
$1,006.08
$1,406.00
$2,136.56
$1,088.38
$1,194.64
$1,307.20
$1,707.12
$1,389.50
$1,495.76
$1,608.32
$2,008.24
$1,690.62
$1,796.88
$1,909.44
$2,309.36
$301.12
Toc - Plan #44 Ambetter from Sunshine Health
Silver

(EPO) Focused Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$400.65
$454.73
$512.02
$715.54
$1,087.34
$707.14
$761.22
$818.51
$1,022.03
$1,013.63
$1,067.71
$1,125.00
$1,328.52
$1,320.12
$1,374.20
$1,431.49
$1,635.01
$306.49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$801.30
$909.46
$1,024.04
$1,431.08
$2,174.68
$1,107.79
$1,215.95
$1,330.53
$1,737.57
$1,414.28
$1,522.44
$1,637.02
$2,044.06
$1,720.77
$1,828.93
$1,943.51
$2,350.55
$306.49
Toc - Plan #45 Ambetter from Sunshine Health
Gold

(EPO) Everyday Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$370.56
$420.58
$473.57
$661.81
$1,005.68
$654.03
$704.05
$757.04
$945.28
$937.50
$987.52
$1,040.51
$1,228.75
$1,220.97
$1,270.99
$1,323.98
$1,512.22
$283.47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$741.12
$841.16
$947.14
$1,323.62
$2,011.36
$1,024.59
$1,124.63
$1,230.61
$1,607.09
$1,308.06
$1,408.10
$1,514.08
$1,890.56
$1,591.53
$1,691.57
$1,797.55
$2,174.03
$283.47
Toc - Plan #46 Ambetter from Sunshine Health
Gold

(EPO) Elite Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$426.27
$483.80
$544.76
$761.29
$1,156.86
$752.36
$809.89
$870.85
$1,087.38
$1,078.45
$1,135.98
$1,196.94
$1,413.47
$1,404.54
$1,462.07
$1,523.03
$1,739.56
$326.09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$852.54
$967.60
$1,089.52
$1,522.58
$2,313.72
$1,178.63
$1,293.69
$1,415.61
$1,848.67
$1,504.72
$1,619.78
$1,741.70
$2,174.76
$1,830.81
$1,945.87
$2,067.79
$2,500.85
$326.09
Toc - Plan #47 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Standard Expanded Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$309.76
$351.56
$395.86
$553.21
$840.66
$546.72
$588.52
$632.82
$790.17
$783.68
$825.48
$869.78
$1,027.13
$1,020.64
$1,062.44
$1,106.74
$1,264.09
$236.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$619.52
$703.12
$791.72
$1,106.42
$1,681.32
$856.48
$940.08
$1,028.68
$1,343.38
$1,093.44
$1,177.04
$1,265.64
$1,580.34
$1,330.40
$1,414.00
$1,502.60
$1,817.30
$236.96
Toc - Plan #48 Ambetter from Sunshine Health
Silver

(EPO) Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$392.30
$445.24
$501.34
$700.62
$1,064.66
$692.40
$745.34
$801.44
$1,000.72
$992.50
$1,045.44
$1,101.54
$1,300.82
$1,292.60
$1,345.54
$1,401.64
$1,600.92
$300.10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$784.60
$890.48
$1,002.68
$1,401.24
$2,129.32
$1,084.70
$1,190.58
$1,302.78
$1,701.34
$1,384.80
$1,490.68
$1,602.88
$2,001.44
$1,684.90
$1,790.78
$1,902.98
$2,301.54
$300.10
Toc - Plan #49 Ambetter from Sunshine Health
Gold

(EPO) Standard Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$368.33
$418.04
$470.71
$657.81
$999.61
$650.09
$699.80
$752.47
$939.57
$931.85
$981.56
$1,034.23
$1,221.33
$1,213.61
$1,263.32
$1,315.99
$1,503.09
$281.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$736.66
$836.08
$941.42
$1,315.62
$1,999.22
$1,018.42
$1,117.84
$1,223.18
$1,597.38
$1,300.18
$1,399.60
$1,504.94
$1,879.14
$1,581.94
$1,681.36
$1,786.70
$2,160.90
$281.76
Toc - Plan #50 Ambetter from Sunshine Health
Silver

(EPO) Everyday Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,400 $16,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$418.09
$474.52
$534.31
$746.69
$1,134.67
$737.92
$794.35
$854.14
$1,066.52
$1,057.75
$1,114.18
$1,173.97
$1,386.35
$1,377.58
$1,434.01
$1,493.80
$1,706.18
$319.83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$836.18
$949.04
$1,068.62
$1,493.38
$2,269.34
$1,156.01
$1,268.87
$1,388.45
$1,813.21
$1,475.84
$1,588.70
$1,708.28
$2,133.04
$1,795.67
$1,908.53
$2,028.11
$2,452.87
$319.83
Toc - Plan #51 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Choice Bronze HSA + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$7,250 $14,500 Annual Deductible
$7,250 $14,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$331.25
$375.96
$423.33
$591.60
$898.99
$584.65
$629.36
$676.73
$845.00
$838.05
$882.76
$930.13
$1,098.40
$1,091.45
$1,136.16
$1,183.53
$1,351.80
$253.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$662.50
$751.92
$846.66
$1,183.20
$1,797.98
$915.90
$1,005.32
$1,100.06
$1,436.60
$1,169.30
$1,258.72
$1,353.46
$1,690.00
$1,422.70
$1,512.12
$1,606.86
$1,943.40
$253.40
Toc - Plan #52 Ambetter from Sunshine Health
Gold

(EPO) Complete Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$401.01
$455.13
$512.48
$716.18
$1,088.31
$707.77
$761.89
$819.24
$1,022.94
$1,014.53
$1,068.65
$1,126.00
$1,329.70
$1,321.29
$1,375.41
$1,432.76
$1,636.46
$306.76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$802.02
$910.26
$1,024.96
$1,432.36
$2,176.62
$1,108.78
$1,217.02
$1,331.72
$1,739.12
$1,415.54
$1,523.78
$1,638.48
$2,045.88
$1,722.30
$1,830.54
$1,945.24
$2,352.64
$306.76
Toc - Plan #53 Ambetter from Sunshine Health
Silver

(EPO) Clear Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$5,400 $10,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$407.18
$462.13
$520.36
$727.20
$1,105.05
$718.66
$773.61
$831.84
$1,038.68
$1,030.14
$1,085.09
$1,143.32
$1,350.16
$1,341.62
$1,396.57
$1,454.80
$1,661.64
$311.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$814.36
$924.26
$1,040.72
$1,454.40
$2,210.10
$1,125.84
$1,235.74
$1,352.20
$1,765.88
$1,437.32
$1,547.22
$1,663.68
$2,077.36
$1,748.80
$1,858.70
$1,975.16
$2,388.84
$311.48
Toc - Plan #54 Ambetter from Sunshine Health
Gold

(EPO) Elite Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$440.94
$500.45
$563.51
$787.50
$1,196.68
$778.25
$837.76
$900.82
$1,124.81
$1,115.56
$1,175.07
$1,238.13
$1,462.12
$1,452.87
$1,512.38
$1,575.44
$1,799.43
$337.31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$881.88
$1,000.90
$1,127.02
$1,575.00
$2,393.36
$1,219.19
$1,338.21
$1,464.33
$1,912.31
$1,556.50
$1,675.52
$1,801.64
$2,249.62
$1,893.81
$2,012.83
$2,138.95
$2,586.93
$337.31
Toc - Plan #55 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Standard Expanded Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$320.42
$363.66
$409.48
$572.25
$869.59
$565.53
$608.77
$654.59
$817.36
$810.64
$853.88
$899.70
$1,062.47
$1,055.75
$1,098.99
$1,144.81
$1,307.58
$245.11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$640.84
$727.32
$818.96
$1,144.50
$1,739.18
$885.95
$972.43
$1,064.07
$1,389.61
$1,131.06
$1,217.54
$1,309.18
$1,634.72
$1,376.17
$1,462.65
$1,554.29
$1,879.83
$245.11
Toc - Plan #56 Ambetter from Sunshine Health
Silver

(EPO) Standard Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$405.80
$460.57
$518.59
$724.73
$1,101.30
$716.23
$771.00
$829.02
$1,035.16
$1,026.66
$1,081.43
$1,139.45
$1,345.59
$1,337.09
$1,391.86
$1,449.88
$1,656.02
$310.43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$811.60
$921.14
$1,037.18
$1,449.46
$2,202.60
$1,122.03
$1,231.57
$1,347.61
$1,759.89
$1,432.46
$1,542.00
$1,658.04
$2,070.32
$1,742.89
$1,852.43
$1,968.47
$2,380.75
$310.43
Toc - Plan #57 Ambetter from Sunshine Health
Gold

(EPO) Standard Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$381.00
$432.43
$486.91
$680.45
$1,034.01
$672.46
$723.89
$778.37
$971.91
$963.92
$1,015.35
$1,069.83
$1,263.37
$1,255.38
$1,306.81
$1,361.29
$1,554.83
$291.46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$762.00
$864.86
$973.82
$1,360.90
$2,068.02
$1,053.46
$1,156.32
$1,265.28
$1,652.36
$1,344.92
$1,447.78
$1,556.74
$1,943.82
$1,636.38
$1,739.24
$1,848.20
$2,235.28
$291.46
Toc - Plan #58 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Everyday Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$8,450 $16,900 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$326.75
$370.85
$417.57
$583.56
$886.77
$576.71
$620.81
$667.53
$833.52
$826.67
$870.77
$917.49
$1,083.48
$1,076.63
$1,120.73
$1,167.45
$1,333.44
$249.96
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$653.50
$741.70
$835.14
$1,167.12
$1,773.54
$903.46
$991.66
$1,085.10
$1,417.08
$1,153.42
$1,241.62
$1,335.06
$1,667.04
$1,403.38
$1,491.58
$1,585.02
$1,917.00
$249.96
Toc - Plan #59 Ambetter from Sunshine Health
Expanded Bronze

(EPO) Elite Bronze + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,250 $18,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$375.16
$425.79
$479.44
$670.02
$1,018.16
$662.15
$712.78
$766.43
$957.01
$949.14
$999.77
$1,053.42
$1,244.00
$1,236.13
$1,286.76
$1,340.41
$1,530.99
$286.99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$750.32
$851.58
$958.88
$1,340.04
$2,036.32
$1,037.31
$1,138.57
$1,245.87
$1,627.03
$1,324.30
$1,425.56
$1,532.86
$1,914.02
$1,611.29
$1,712.55
$1,819.85
$2,201.01
$286.99
Toc - Plan #60 Ambetter from Sunshine Health
Silver

(EPO) Focused Silver + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$414.44
$470.38
$529.64
$740.17
$1,124.76
$731.48
$787.42
$846.68
$1,057.21
$1,048.52
$1,104.46
$1,163.72
$1,374.25
$1,365.56
$1,421.50
$1,480.76
$1,691.29
$317.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$828.88
$940.76
$1,059.28
$1,480.34
$2,249.52
$1,145.92
$1,257.80
$1,376.32
$1,797.38
$1,462.96
$1,574.84
$1,693.36
$2,114.42
$1,780.00
$1,891.88
$2,010.40
$2,431.46
$317.04
Toc - Plan #61 Ambetter from Sunshine Health
Gold

(EPO) Everyday Gold + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1169

Annual Out of Pocket Expenses:

Individual Family
$750 $1,500 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$383.32
$435.05
$489.86
$684.58
$1,040.29
$676.55
$728.28
$783.09
$977.81
$969.78
$1,021.51
$1,076.32
$1,271.04
$1,263.01
$1,314.74
$1,369.55
$1,564.27
$293.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$766.64
$870.10
$979.72
$1,369.16
$2,080.58
$1,059.87
$1,163.33
$1,272.95
$1,662.39
$1,353.10
$1,456.56
$1,566.18
$1,955.62
$1,646.33
$1,749.79
$1,859.41
$2,248.85
$293.23

ADVERTISEMENT

Florida Blue HMO (a BlueCross BlueShield FL company)

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583 | TTY: 1-800-955-8771

Toc - Plan #62 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) myBlue Bronze 1601 ($0 Virtual Visits / 3 PCP Visits for $0 then $45 / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$375.93
$426.68
$480.44
$671.41
$1,020.27
$663.52
$714.27
$768.03
$959.00
$951.11
$1,001.86
$1,055.62
$1,246.59
$1,238.70
$1,289.45
$1,343.21
$1,534.18
$287.59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$751.86
$853.36
$960.88
$1,342.82
$2,040.54
$1,039.45
$1,140.95
$1,248.47
$1,630.41
$1,327.04
$1,428.54
$1,536.06
$1,918.00
$1,614.63
$1,716.13
$1,823.65
$2,205.59
$287.59
Toc - Plan #63 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(HMO) myBlue Gold 1605 ($0 Virtual Visits / $0 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$940 $1,880 Annual Deductible
$4,700 $9,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$509.47
$578.25
$651.10
$909.91
$1,382.70
$899.21
$967.99
$1,040.84
$1,299.65
$1,288.95
$1,357.73
$1,430.58
$1,689.39
$1,678.69
$1,747.47
$1,820.32
$2,079.13
$389.74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,018.94
$1,156.50
$1,302.20
$1,819.82
$2,765.40
$1,408.68
$1,546.24
$1,691.94
$2,209.56
$1,798.42
$1,935.98
$2,081.68
$2,599.30
$2,188.16
$2,325.72
$2,471.42
$2,989.04
$389.74
Toc - Plan #64 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 2017 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$435.75
$494.58
$556.89
$778.25
$1,182.63
$769.10
$827.93
$890.24
$1,111.60
$1,102.45
$1,161.28
$1,223.59
$1,444.95
$1,435.80
$1,494.63
$1,556.94
$1,778.30
$333.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$871.50
$989.16
$1,113.78
$1,556.50
$2,365.26
$1,204.85
$1,322.51
$1,447.13
$1,889.85
$1,538.20
$1,655.86
$1,780.48
$2,223.20
$1,871.55
$1,989.21
$2,113.83
$2,556.55
$333.35
Toc - Plan #65 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) myBlue Bronze 2129 ($0 Virtual Visits / $35 PCP Visit / $75 Specialist Visits / $30 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$395.66
$449.07
$505.65
$706.65
$1,073.82
$698.34
$751.75
$808.33
$1,009.33
$1,001.02
$1,054.43
$1,111.01
$1,312.01
$1,303.70
$1,357.11
$1,413.69
$1,614.69
$302.68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$791.32
$898.14
$1,011.30
$1,413.30
$2,147.64
$1,094.00
$1,200.82
$1,313.98
$1,715.98
$1,396.68
$1,503.50
$1,616.66
$2,018.66
$1,699.36
$1,806.18
$1,919.34
$2,321.34
$302.68
Toc - Plan #66 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 2237 ($0 Virtual Visits / $60 PCP Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$4,100 $8,200 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$413.33
$469.13
$528.24
$738.21
$1,121.78
$729.53
$785.33
$844.44
$1,054.41
$1,045.73
$1,101.53
$1,160.64
$1,370.61
$1,361.93
$1,417.73
$1,476.84
$1,686.81
$316.20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$826.66
$938.26
$1,056.48
$1,476.42
$2,243.56
$1,142.86
$1,254.46
$1,372.68
$1,792.62
$1,459.06
$1,570.66
$1,688.88
$2,108.82
$1,775.26
$1,886.86
$2,005.08
$2,425.02
$316.20
Toc - Plan #67 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) myBlue Bronze 2219 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,650 $3,300 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$368.05
$417.74
$470.37
$657.34
$998.89
$649.61
$699.30
$751.93
$938.90
$931.17
$980.86
$1,033.49
$1,220.46
$1,212.73
$1,262.42
$1,315.05
$1,502.02
$281.56
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$736.10
$835.48
$940.74
$1,314.68
$1,997.78
$1,017.66
$1,117.04
$1,222.30
$1,596.24
$1,299.22
$1,398.60
$1,503.86
$1,877.80
$1,580.78
$1,680.16
$1,785.42
$2,159.36
$281.56
Toc - Plan #68 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) myBlue Bronze 2312S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$356.39
$404.50
$455.47
$636.51
$967.24
$629.03
$677.14
$728.11
$909.15
$901.67
$949.78
$1,000.75
$1,181.79
$1,174.31
$1,222.42
$1,273.39
$1,454.43
$272.64
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$712.78
$809.00
$910.94
$1,273.02
$1,934.48
$985.42
$1,081.64
$1,183.58
$1,545.66
$1,258.06
$1,354.28
$1,456.22
$1,818.30
$1,530.70
$1,626.92
$1,728.86
$2,090.94
$272.64
Toc - Plan #69 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(HMO) myBlue Bronze 2329 ($0 Virtual Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$386.44
$438.61
$493.87
$690.18
$1,048.80
$682.07
$734.24
$789.50
$985.81
$977.70
$1,029.87
$1,085.13
$1,281.44
$1,273.33
$1,325.50
$1,380.76
$1,577.07
$295.63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$772.88
$877.22
$987.74
$1,380.36
$2,097.60
$1,068.51
$1,172.85
$1,283.37
$1,675.99
$1,364.14
$1,468.48
$1,579.00
$1,971.62
$1,659.77
$1,764.11
$1,874.63
$2,267.25
$295.63
Toc - Plan #70 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 24M06-50 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$440.58
$500.06
$563.06
$786.88
$1,195.73
$777.62
$837.10
$900.10
$1,123.92
$1,114.66
$1,174.14
$1,237.14
$1,460.96
$1,451.70
$1,511.18
$1,574.18
$1,798.00
$337.04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$881.16
$1,000.12
$1,126.12
$1,573.76
$2,391.46
$1,218.20
$1,337.16
$1,463.16
$1,910.80
$1,555.24
$1,674.20
$1,800.20
$2,247.84
$1,892.28
$2,011.24
$2,137.24
$2,584.88
$337.04
Toc - Plan #71 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 2313S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$436.17
$495.05
$557.43
$779.00
$1,183.77
$769.84
$828.72
$891.10
$1,112.67
$1,103.51
$1,162.39
$1,224.77
$1,446.34
$1,437.18
$1,496.06
$1,558.44
$1,780.01
$333.67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$872.34
$990.10
$1,114.86
$1,558.00
$2,367.54
$1,206.01
$1,323.77
$1,448.53
$1,891.67
$1,539.68
$1,657.44
$1,782.20
$2,225.34
$1,873.35
$1,991.11
$2,115.87
$2,559.01
$333.67
Toc - Plan #72 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(HMO) myBlue Gold 2314S ($30 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$502.33
$570.14
$641.98
$897.16
$1,363.32
$886.61
$954.42
$1,026.26
$1,281.44
$1,270.89
$1,338.70
$1,410.54
$1,665.72
$1,655.17
$1,722.98
$1,794.82
$2,050.00
$384.28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,004.66
$1,140.28
$1,283.96
$1,794.32
$2,726.64
$1,388.94
$1,524.56
$1,668.24
$2,178.60
$1,773.22
$1,908.84
$2,052.52
$2,562.88
$2,157.50
$2,293.12
$2,436.80
$2,947.16
$384.28
Toc - Plan #73 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(HMO) myBlue Gold 24M05-74 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$5,950 $11,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$528.02
$599.30
$674.81
$943.04
$1,433.05
$931.96
$1,003.24
$1,078.75
$1,346.98
$1,335.90
$1,407.18
$1,482.69
$1,750.92
$1,739.84
$1,811.12
$1,886.63
$2,154.86
$403.94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,056.04
$1,198.60
$1,349.62
$1,886.08
$2,866.10
$1,459.98
$1,602.54
$1,753.56
$2,290.02
$1,863.92
$2,006.48
$2,157.50
$2,693.96
$2,267.86
$2,410.42
$2,561.44
$3,097.90
$403.94
Toc - Plan #74 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum

(HMO) myBlue Platinum 24M05-75 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$647.52
$734.94
$827.53
$1,156.47
$1,757.37
$1,142.87
$1,230.29
$1,322.88
$1,651.82
$1,638.22
$1,725.64
$1,818.23
$2,147.17
$2,133.57
$2,220.99
$2,313.58
$2,642.52
$495.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,295.04
$1,469.88
$1,655.06
$2,312.94
$3,514.74
$1,790.39
$1,965.23
$2,150.41
$2,808.29
$2,285.74
$2,460.58
$2,645.76
$3,303.64
$2,781.09
$2,955.93
$3,141.11
$3,798.99
$495.35
Toc - Plan #75 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 24M06-76 ($0 Virtual Visits / $10 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$7,600 $15,200 Annual Deductible
$9,200 $18,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$405.01
$459.69
$517.60
$723.35
$1,099.20
$714.84
$769.52
$827.43
$1,033.18
$1,024.67
$1,079.35
$1,137.26
$1,343.01
$1,334.50
$1,389.18
$1,447.09
$1,652.84
$309.83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$810.02
$919.38
$1,035.20
$1,446.70
$2,198.40
$1,119.85
$1,229.21
$1,345.03
$1,756.53
$1,429.68
$1,539.04
$1,654.86
$2,066.36
$1,739.51
$1,848.87
$1,964.69
$2,376.19
$309.83
Toc - Plan #76 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum

(HMO) myBlue Platinum 24M05-00S ($0 Deductible / $10 PCP Visits / Multilingual Available / Rewards $$$ )

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$644.83
$731.88
$824.09
$1,151.67
$1,750.07
$1,138.12
$1,225.17
$1,317.38
$1,644.96
$1,631.41
$1,718.46
$1,810.67
$2,138.25
$2,124.70
$2,211.75
$2,303.96
$2,631.54
$493.29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,289.66
$1,463.76
$1,648.18
$2,303.34
$3,500.14
$1,782.95
$1,957.05
$2,141.47
$2,796.63
$2,276.24
$2,450.34
$2,634.76
$3,289.92
$2,769.53
$2,943.63
$3,128.05
$3,783.21
$493.29
Toc - Plan #77 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 2237D ($0 Virtual Visits / $60 PCP Visits / Adult Dental / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$4,100 $8,200 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$421.59
$478.50
$538.79
$752.96
$1,144.20
$744.11
$801.02
$861.31
$1,075.48
$1,066.63
$1,123.54
$1,183.83
$1,398.00
$1,389.15
$1,446.06
$1,506.35
$1,720.52
$322.52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$843.18
$957.00
$1,077.58
$1,505.92
$2,288.40
$1,165.70
$1,279.52
$1,400.10
$1,828.44
$1,488.22
$1,602.04
$1,722.62
$2,150.96
$1,810.74
$1,924.56
$2,045.14
$2,473.48
$322.52
Toc - Plan #78 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(HMO) myBlue Silver 24M06-76D ($0 Virtual Visits / Adult Dental / $10 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$7,600 $15,200 Annual Deductible
$9,200 $18,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$413.32
$469.12
$528.22
$738.19
$1,121.75
$729.51
$785.31
$844.41
$1,054.38
$1,045.70
$1,101.50
$1,160.60
$1,370.57
$1,361.89
$1,417.69
$1,476.79
$1,686.76
$316.19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$826.64
$938.24
$1,056.44
$1,476.38
$2,243.50
$1,142.83
$1,254.43
$1,372.63
$1,792.57
$1,459.02
$1,570.62
$1,688.82
$2,108.76
$1,775.21
$1,886.81
$2,005.01
$2,424.95
$316.19
Toc - Plan #79 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(POS) BlueCare Silver 24K01-02 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$483.27
$548.51
$617.62
$863.12
$1,311.59
$852.97
$918.21
$987.32
$1,232.82
$1,222.67
$1,287.91
$1,357.02
$1,602.52
$1,592.37
$1,657.61
$1,726.72
$1,972.22
$369.70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$966.54
$1,097.02
$1,235.24
$1,726.24
$2,623.18
$1,336.24
$1,466.72
$1,604.94
$2,095.94
$1,705.94
$1,836.42
$1,974.64
$2,465.64
$2,075.64
$2,206.12
$2,344.34
$2,835.34
$369.70
Toc - Plan #80 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(POS) BlueCare Bronze 24K01-03 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$407.76
$462.81
$521.12
$728.26
$1,106.66
$719.70
$774.75
$833.06
$1,040.20
$1,031.64
$1,086.69
$1,145.00
$1,352.14
$1,343.58
$1,398.63
$1,456.94
$1,664.08
$311.94
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$815.52
$925.62
$1,042.24
$1,456.52
$2,213.32
$1,127.46
$1,237.56
$1,354.18
$1,768.46
$1,439.40
$1,549.50
$1,666.12
$2,080.40
$1,751.34
$1,861.44
$1,978.06
$2,392.34
$311.94
Toc - Plan #81 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum

(POS) BlueCare Platinum 24K01-04 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$4,000 $8,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$660.49
$749.66
$844.11
$1,179.64
$1,792.57
$1,165.76
$1,254.93
$1,349.38
$1,684.91
$1,671.03
$1,760.20
$1,854.65
$2,190.18
$2,176.30
$2,265.47
$2,359.92
$2,695.45
$505.27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,320.98
$1,499.32
$1,688.22
$2,359.28
$3,585.14
$1,826.25
$2,004.59
$2,193.49
$2,864.55
$2,331.52
$2,509.86
$2,698.76
$3,369.82
$2,836.79
$3,015.13
$3,204.03
$3,875.09
$505.27
Toc - Plan #82 Florida Blue HMO (a BlueCross BlueShield FL company)
Bronze

(POS) BlueCare Bronze 24K01-05 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$6,150 $12,300 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$371.54
$421.70
$474.83
$663.57
$1,008.36
$655.77
$705.93
$759.06
$947.80
$940.00
$990.16
$1,043.29
$1,232.03
$1,224.23
$1,274.39
$1,327.52
$1,516.26
$284.23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$743.08
$843.40
$949.66
$1,327.14
$2,016.72
$1,027.31
$1,127.63
$1,233.89
$1,611.37
$1,311.54
$1,411.86
$1,518.12
$1,895.60
$1,595.77
$1,696.09
$1,802.35
$2,179.83
$284.23
Toc - Plan #83 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(POS) BlueCare Silver 24K01-06 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$2,800 $5,600 Annual Deductible
$7,150 $14,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$531.89
$603.70
$679.76
$949.96
$1,443.55
$938.79
$1,010.60
$1,086.66
$1,356.86
$1,345.69
$1,417.50
$1,493.56
$1,763.76
$1,752.59
$1,824.40
$1,900.46
$2,170.66
$406.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,063.78
$1,207.40
$1,359.52
$1,899.92
$2,887.10
$1,470.68
$1,614.30
$1,766.42
$2,306.82
$1,877.58
$2,021.20
$2,173.32
$2,713.72
$2,284.48
$2,428.10
$2,580.22
$3,120.62
$406.90
Toc - Plan #84 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum

(POS) BlueCare Platinum 24K01-07 ($0 Virtual Visits / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$2,000 $4,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$694.57
$788.34
$887.66
$1,240.50
$1,885.06
$1,225.92
$1,319.69
$1,419.01
$1,771.85
$1,757.27
$1,851.04
$1,950.36
$2,303.20
$2,288.62
$2,382.39
$2,481.71
$2,834.55
$531.35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,389.14
$1,576.68
$1,775.32
$2,481.00
$3,770.12
$1,920.49
$2,108.03
$2,306.67
$3,012.35
$2,451.84
$2,639.38
$2,838.02
$3,543.70
$2,983.19
$3,170.73
$3,369.37
$4,075.05
$531.35
Toc - Plan #85 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(POS) BlueCare Gold 24K01-08 ($0 Virtual Visits / $20 PCP Visit / $15 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$6,250 $12,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$600.86
$681.98
$767.90
$1,073.14
$1,630.73
$1,060.52
$1,141.64
$1,227.56
$1,532.80
$1,520.18
$1,601.30
$1,687.22
$1,992.46
$1,979.84
$2,060.96
$2,146.88
$2,452.12
$459.66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,201.72
$1,363.96
$1,535.80
$2,146.28
$3,261.46
$1,661.38
$1,823.62
$1,995.46
$2,605.94
$2,121.04
$2,283.28
$2,455.12
$3,065.60
$2,580.70
$2,742.94
$2,914.78
$3,525.26
$459.66
Toc - Plan #86 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(POS) BlueCare Bronze (HSA) 24K01-09 (Rewards $$$ / $4 Condition Care Rx)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$7,050 $14,100 Annual Deductible
$7,050 $14,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$390.48
$443.19
$499.03
$697.40
$1,059.76
$689.20
$741.91
$797.75
$996.12
$987.92
$1,040.63
$1,096.47
$1,294.84
$1,286.64
$1,339.35
$1,395.19
$1,593.56
$298.72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$780.96
$886.38
$998.06
$1,394.80
$2,119.52
$1,079.68
$1,185.10
$1,296.78
$1,693.52
$1,378.40
$1,483.82
$1,595.50
$1,992.24
$1,677.12
$1,782.54
$1,894.22
$2,290.96
$298.72
Toc - Plan #87 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(POS) BlueCare Gold 24K01-10 ($0 Virtual Visits / $20 Labs / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$5,900 $11,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$576.43
$654.25
$736.68
$1,029.50
$1,564.43
$1,017.40
$1,095.22
$1,177.65
$1,470.47
$1,458.37
$1,536.19
$1,618.62
$1,911.44
$1,899.34
$1,977.16
$2,059.59
$2,352.41
$440.97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,152.86
$1,308.50
$1,473.36
$2,059.00
$3,128.86
$1,593.83
$1,749.47
$1,914.33
$2,499.97
$2,034.80
$2,190.44
$2,355.30
$2,940.94
$2,475.77
$2,631.41
$2,796.27
$3,381.91
$440.97
Toc - Plan #88 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(POS) BlueCare Bronze 24K01-25 ($0 Virtual Visits / $50 PCP Visit / $30 Generic Meds / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$435.07
$493.80
$556.02
$777.04
$1,180.78
$767.90
$826.63
$888.85
$1,109.87
$1,100.73
$1,159.46
$1,221.68
$1,442.70
$1,433.56
$1,492.29
$1,554.51
$1,775.53
$332.83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$870.14
$987.60
$1,112.04
$1,554.08
$2,361.56
$1,202.97
$1,320.43
$1,444.87
$1,886.91
$1,535.80
$1,653.26
$1,777.70
$2,219.74
$1,868.63
$1,986.09
$2,110.53
$2,552.57
$332.83
Toc - Plan #89 Florida Blue HMO (a BlueCross BlueShield FL company)
Expanded Bronze

(POS) BlueCare Bronze 24K01-31S (Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$397.26
$450.89
$507.70
$709.51
$1,078.16
$701.16
$754.79
$811.60
$1,013.41
$1,005.06
$1,058.69
$1,115.50
$1,317.31
$1,308.96
$1,362.59
$1,419.40
$1,621.21
$303.90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$794.52
$901.78
$1,015.40
$1,419.02
$2,156.32
$1,098.42
$1,205.68
$1,319.30
$1,722.92
$1,402.32
$1,509.58
$1,623.20
$2,026.82
$1,706.22
$1,813.48
$1,927.10
$2,330.72
$303.90
Toc - Plan #90 Florida Blue HMO (a BlueCross BlueShield FL company)
Silver

(POS) BlueCare Silver 24K01-32S ($40 PCP Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$511.79
$580.88
$654.07
$914.06
$1,389.00
$903.31
$972.40
$1,045.59
$1,305.58
$1,294.83
$1,363.92
$1,437.11
$1,697.10
$1,686.35
$1,755.44
$1,828.63
$2,088.62
$391.52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,023.58
$1,161.76
$1,308.14
$1,828.12
$2,778.00
$1,415.10
$1,553.28
$1,699.66
$2,219.64
$1,806.62
$1,944.80
$2,091.18
$2,611.16
$2,198.14
$2,336.32
$2,482.70
$3,002.68
$391.52
Toc - Plan #91 Florida Blue HMO (a BlueCross BlueShield FL company)
Gold

(POS) BlueCare Gold 24K01-33S ($30 PCP Visit / Multilingual Available/ Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$558.66
$634.08
$713.97
$997.77
$1,516.20
$986.03
$1,061.45
$1,141.34
$1,425.14
$1,413.40
$1,488.82
$1,568.71
$1,852.51
$1,840.77
$1,916.19
$1,996.08
$2,279.88
$427.37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,117.32
$1,268.16
$1,427.94
$1,995.54
$3,032.40
$1,544.69
$1,695.53
$1,855.31
$2,422.91
$1,972.06
$2,122.90
$2,282.68
$2,850.28
$2,399.43
$2,550.27
$2,710.05
$3,277.65
$427.37
Toc - Plan #92 Florida Blue HMO (a BlueCross BlueShield FL company)
Platinum

(POS) BlueCare Platinum 24K01-34S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-352-2583

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$3,200 $6,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$692.37
$785.84
$884.85
$1,236.57
$1,879.09
$1,222.03
$1,315.50
$1,414.51
$1,766.23
$1,751.69
$1,845.16
$1,944.17
$2,295.89
$2,281.35
$2,374.82
$2,473.83
$2,825.55
$529.66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1,384.74
$1,571.68
$1,769.70
$2,473.14
$3,758.18
$1,914.40
$2,101.34
$2,299.36
$3,002.80
$2,444.06
$2,631.00
$2,829.02
$3,532.46
$2,973.72
$3,160.66
$3,358.68
$4,062.12
$529.66

ADVERTISEMENT

Oscar Insurance Company of Florida

Local: 1-855-672-2755 | Toll Free: 1-855-672-2755

Toc - Plan #93 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Bronze Elite + PCP Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$353.26
$400.94
$451.45
$630.91
$958.72
$623.50
$671.18
$721.69
$901.15
$893.74
$941.42
$991.93
$1,171.39
$1,163.98
$1,211.66
$1,262.17
$1,441.63
$270.24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$706.52
$801.88
$902.90
$1,261.82
$1,917.44
$976.76
$1,072.12
$1,173.14
$1,532.06
$1,247.00
$1,342.36
$1,443.38
$1,802.30
$1,517.24
$1,612.60
$1,713.62
$2,072.54
$270.24
Toc - Plan #94 Oscar Insurance Company of Florida
Silver

(EPO) Silver Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$8,650 $17,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$389.29
$441.84
$497.50
$695.26
$1,056.51
$687.09
$739.64
$795.30
$993.06
$984.89
$1,037.44
$1,093.10
$1,290.86
$1,282.69
$1,335.24
$1,390.90
$1,588.66
$297.80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$778.58
$883.68
$995.00
$1,390.52
$2,113.02
$1,076.38
$1,181.48
$1,292.80
$1,688.32
$1,374.18
$1,479.28
$1,590.60
$1,986.12
$1,671.98
$1,777.08
$1,888.40
$2,283.92
$297.80
Toc - Plan #95 Oscar Insurance Company of Florida
Catastrophic

(EPO) Secure

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$9,450 $18,900 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$235.39
$267.15
$300.81
$420.38
$638.81
$415.45
$447.21
$480.87
$600.44
$595.51
$627.27
$660.93
$780.50
$775.57
$807.33
$840.99
$960.56
$180.06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$470.78
$534.30
$601.62
$840.76
$1,277.62
$650.84
$714.36
$781.68
$1,020.82
$830.90
$894.42
$961.74
$1,200.88
$1,010.96
$1,074.48
$1,141.80
$1,380.94
$180.06
Toc - Plan #96 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Bronze Elite + Specialist Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$355.40
$403.37
$454.19
$634.73
$964.53
$627.27
$675.24
$726.06
$906.60
$899.14
$947.11
$997.93
$1,178.47
$1,171.01
$1,218.98
$1,269.80
$1,450.34
$271.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$710.80
$806.74
$908.38
$1,269.46
$1,929.06
$982.67
$1,078.61
$1,180.25
$1,541.33
$1,254.54
$1,350.48
$1,452.12
$1,813.20
$1,526.41
$1,622.35
$1,723.99
$2,085.07
$271.87
Toc - Plan #97 Oscar Insurance Company of Florida
Gold

(EPO) Gold Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$413.19
$468.96
$528.05
$737.94
$1,121.38
$729.27
$785.04
$844.13
$1,054.02
$1,045.35
$1,101.12
$1,160.21
$1,370.10
$1,361.43
$1,417.20
$1,476.29
$1,686.18
$316.08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$826.38
$937.92
$1,056.10
$1,475.88
$2,242.76
$1,142.46
$1,254.00
$1,372.18
$1,791.96
$1,458.54
$1,570.08
$1,688.26
$2,108.04
$1,774.62
$1,886.16
$2,004.34
$2,424.12
$316.08
Toc - Plan #98 Oscar Insurance Company of Florida
Silver

(EPO) Silver Simple

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 Annual Deductible
$9,000 $18,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$388.29
$440.70
$496.22
$693.47
$1,053.79
$685.32
$737.73
$793.25
$990.50
$982.35
$1,034.76
$1,090.28
$1,287.53
$1,279.38
$1,331.79
$1,387.31
$1,584.56
$297.03
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$776.58
$881.40
$992.44
$1,386.94
$2,107.58
$1,073.61
$1,178.43
$1,289.47
$1,683.97
$1,370.64
$1,475.46
$1,586.50
$1,981.00
$1,667.67
$1,772.49
$1,883.53
$2,278.03
$297.03
Toc - Plan #99 Oscar Insurance Company of Florida
Silver

(EPO) Silver Elite

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$396.27
$449.75
$506.41
$707.71
$1,075.44
$699.41
$752.89
$809.55
$1,010.85
$1,002.55
$1,056.03
$1,112.69
$1,313.99
$1,305.69
$1,359.17
$1,415.83
$1,617.13
$303.14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$792.54
$899.50
$1,012.82
$1,415.42
$2,150.88
$1,095.68
$1,202.64
$1,315.96
$1,718.56
$1,398.82
$1,505.78
$1,619.10
$2,021.70
$1,701.96
$1,808.92
$1,922.24
$2,324.84
$303.14
Toc - Plan #100 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Bronze Classic 4700

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$4,700 $9,400 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$319.78
$362.94
$408.66
$571.11
$867.85
$564.40
$607.56
$653.28
$815.73
$809.02
$852.18
$897.90
$1,060.35
$1,053.64
$1,096.80
$1,142.52
$1,304.97
$244.62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$639.56
$725.88
$817.32
$1,142.22
$1,735.70
$884.18
$970.50
$1,061.94
$1,386.84
$1,128.80
$1,215.12
$1,306.56
$1,631.46
$1,373.42
$1,459.74
$1,551.18
$1,876.08
$244.62
Toc - Plan #101 Oscar Insurance Company of Florida
Silver

(EPO) Silver Simple PCP Saver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$8,900 $17,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$385.46
$437.49
$492.61
$688.41
$1,046.11
$680.33
$732.36
$787.48
$983.28
$975.20
$1,027.23
$1,082.35
$1,278.15
$1,270.07
$1,322.10
$1,377.22
$1,573.02
$294.87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$770.92
$874.98
$985.22
$1,376.82
$2,092.22
$1,065.79
$1,169.85
$1,280.09
$1,671.69
$1,360.66
$1,464.72
$1,574.96
$1,966.56
$1,655.53
$1,759.59
$1,869.83
$2,261.43
$294.87
Toc - Plan #102 Oscar Insurance Company of Florida
Gold

(EPO) Gold Elite Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$451.15
$512.04
$576.55
$805.73
$1,224.39
$796.27
$857.16
$921.67
$1,150.85
$1,141.39
$1,202.28
$1,266.79
$1,495.97
$1,486.51
$1,547.40
$1,611.91
$1,841.09
$345.12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$902.30
$1,024.08
$1,153.10
$1,611.46
$2,448.78
$1,247.42
$1,369.20
$1,498.22
$1,956.58
$1,592.54
$1,714.32
$1,843.34
$2,301.70
$1,937.66
$2,059.44
$2,188.46
$2,646.82
$345.12
Toc - Plan #103 Oscar Insurance Company of Florida
Gold

(EPO) Gold Elite

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$428.38
$486.20
$547.46
$765.07
$1,162.60
$756.09
$813.91
$875.17
$1,092.78
$1,083.80
$1,141.62
$1,202.88
$1,420.49
$1,411.51
$1,469.33
$1,530.59
$1,748.20
$327.71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$856.76
$972.40
$1,094.92
$1,530.14
$2,325.20
$1,184.47
$1,300.11
$1,422.63
$1,857.85
$1,512.18
$1,627.82
$1,750.34
$2,185.56
$1,839.89
$1,955.53
$2,078.05
$2,513.27
$327.71
Toc - Plan #104 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Bronze Elite Saver Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$9,450 $18,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$346.94
$393.77
$443.38
$619.62
$941.57
$612.34
$659.17
$708.78
$885.02
$877.74
$924.57
$974.18
$1,150.42
$1,143.14
$1,189.97
$1,239.58
$1,415.82
$265.40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$693.88
$787.54
$886.76
$1,239.24
$1,883.14
$959.28
$1,052.94
$1,152.16
$1,504.64
$1,224.68
$1,318.34
$1,417.56
$1,770.04
$1,490.08
$1,583.74
$1,682.96
$2,035.44
$265.40
Toc - Plan #105 Oscar Insurance Company of Florida
Expanded Bronze

(EPO) Bronze Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$9,400 $18,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$316.95
$359.72
$405.05
$566.05
$860.17
$559.41
$602.18
$647.51
$808.51
$801.87
$844.64
$889.97
$1,050.97
$1,044.33
$1,087.10
$1,132.43
$1,293.43
$242.46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$633.90
$719.44
$810.10
$1,132.10
$1,720.34
$876.36
$961.90
$1,052.56
$1,374.56
$1,118.82
$1,204.36
$1,295.02
$1,617.02
$1,361.28
$1,446.82
$1,537.48
$1,859.48
$242.46
Toc - Plan #106 Oscar Insurance Company of Florida
Silver

(EPO) Silver Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$9,100 $18,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$386.26
$438.39
$493.62
$689.83
$1,048.27
$681.74
$733.87
$789.10
$985.31
$977.22
$1,029.35
$1,084.58
$1,280.79
$1,272.70
$1,324.83
$1,380.06
$1,576.27
$295.48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$772.52
$876.78
$987.24
$1,379.66
$2,096.54
$1,068.00
$1,172.26
$1,282.72
$1,675.14
$1,363.48
$1,467.74
$1,578.20
$1,970.62
$1,658.96
$1,763.22
$1,873.68
$2,266.10
$295.48
Toc - Plan #107 Oscar Insurance Company of Florida
Gold

(EPO) Gold Classic Standard

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-672-2755

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,700 $17,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$399.37
$453.28
$510.38
$713.26
$1,083.87
$704.88
$758.79
$815.89
$1,018.77
$1,010.39
$1,064.30
$1,121.40
$1,324.28
$1,315.90
$1,369.81
$1,426.91
$1,629.79
$305.51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$798.74
$906.56
$1,020.76
$1,426.52
$2,167.74
$1,104.25
$1,212.07
$1,326.27
$1,732.03
$1,409.76
$1,517.58
$1,631.78
$2,037.54
$1,715.27
$1,823.09
$1,937.29
$2,343.05
$305.51

‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Charlotte County here.

Charlotte County is in “Rating Area 8” of Florida.

Currently, there are 107 plans offered in Rating Area 8.

Top

2024 Obamacare Plans for Charlotte County, FL

Plan Browser: 107 Plans
scroll down for more

Speak with a Health Insurance Expert 800-943-6832Ads by +HealthNetwork Speak with a Health Insurance Expert 800-943-6832Ads by +HealthNetwork